DIGESTIVE SYSTEM

Definition
The digestive system is the collective name used to describe the alimentary canal,
some accessory organs and variety of digestive processes which takes place at
different level in the canal l to prepare food eaten for absorption.

Organs of digestive system:

I. Alimentary tract:

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 • The alimentary tract begins at the mouth, passes through the thorax, abdomen
and pelvis and ends at the anus.
• The parts of alimentary canal are:
1. Mouth
2. Pharynx
3. Oesophagus
4. Stomach
5. Small intestine
6. Large intestine
7. Rectum
8. anus

II. Accessory Organs:

• Various secretions are passed into the alimentary track some by glands in the
lining of stomach and some by glands situated outside the track which are
called the accessory organs of the digestion.
• They consist of:
1. Salivary glands (3 pairs)
2. Pancreas
3. Liver
4. Gall bladder
• The organs and glands are linked physiologically and anatomically in their
digestions and absorption occurring in different stages.
Functions of the digestive system:
• There are six basic functions of the digestive system:
1. Ingestion: it is the process of taking food into the mouth (eating)
2. Secretion: It is the release of water, acid, buffers, and enzymes into the
lumen of GI tract.
3. Mixing and Propulsion: it is the process of chewing and propulsion of
food through the GI tract by alternative contractions and relaxations of
smooth muscle in the wall of GI tract.
4. Digestion: it is the mechanical and chemical breakdown of food into
small molecules by hydrolysis.
5. Absorption: it is the passage of the digested products from the GI into
blood and lymph.
6. Defecation: it is the elimination of feces (waste, indigestive substances,
bacteria, cell sloughed from the lining of the GI tract and the digested
unabsorbed material) from the GI tract.

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 MOUTH

• The mouth (oral or buccal cavity) is formed by the check hard palate, soft palate
and tongue.

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 • The mouth is bounded by muscles and bones

Anteriorly: by the lips

Posteriorly: it is continuous with oropharynx, laterally: muscles of cheek
Superiorly: by the bony hard palate and muscular soft palate,
Inferiorly by the muscular tongue and the soft tissues of the floor of the mouth.
• The cheeks are externally covered by the skin and internally by mucus
membrane. Anterior portion of the cheeks end at the lips.
• The lips [labia] are fleshly fold surrounding the opening 0f the mouth covered
externally by skin and internally by mucus membrane
• The inner surface of each lips is attached to its corresponding gum by a middle
line fold of mucus membrane called labial frenulum.
• The vestibule of the oral cavity is space bounded externally by the cheeks and
lips and internally by gums and teeth.
• The oral cavity proper extent from the gum and teeth to the faucets
• Opening between the mouth and the oropharynx is called faucets.

Hard palates
• It is the anterior portion of the roof of the mouth
• It is formed by the maxillae and palatine bone and is covered by mucus
membrane
• It forms the bony partition between the oral and nasal cavities

Soft palates:
• The soft palate is the posterior portion of the roof of the mouth
• The five muscles of the soft palate play important role in swallowing and
breathing are:
o Tensor veli palatini – involved in swallowing
o Palatoglossous – involved in swallowing
o Palatopharyngous– breathing
o Levator veli palatini – swallowing
o Musculosos uvulae – moves uvulae

Soft palatine is movable consisting of muscle fibers sheathed in mucus membrane

Nerve Supply:
The muscles are supplied by the pharyngeal plexus through Vagus nerve except
tensor veli palatini which is supplied by cranial nerve

Blood supply:
It is supplied by lesser palatine arteries, ascending palatine artery

Function:
• The soft palate is responsible for closing of the nasal passage during the act of
swallowing and of closing of airway
• During sneezing it protects the nasal passage by diverting a portion of excreted
substance to the mouth

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 • A speech sound made with the middle part of the tongue touching the soft
palate known as a velar consonant
• The soft palate retracts and elevate during the speech to separate oral cavity
from nasal cavity to produce oral cavity sound.

Uvula:
• The uvula is a curved fold of muscle covered with mucus membrane, hanging
down from the free border of the soft palate.
• During swallowing, the soft palate and uvula close off the nasopharynx
• Lateral to the base of the uvula are 2 muscular fold
o Anterior: - palatoglossal arch
o Posterior: - palatopharyngeal arch
• On each side between the two arches a collection of lymphoid tissue called the
palatine tonsil

TONGUE
• It is an accessory organ composed of voluntary skeletal muscle covered with
mucus membrane
• The tongue with the associated muscles forms the floor of the oral cavity
• The tongue is attached to mandible, the styloid process of the temporal bone
and the hyoid bone.

• A medial septum extends the entire length of the tongue divided into symmetrical
halves

Muscles of Tongue

• Beneath the mucus membrane each half of the tongue is composed of same
number and type of intrinsic and extrinsic skeletal muscles.

Intrinsic muscles: -

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 • Longitudinally inferior, longitudinally superior, transverses, linguae, verticals
linguae muscles

• These muscles allow to change the shape and size of the tongue

Extrinsic Muscles:
• Mylohyoid, hyoglossus styloglossus and genioglossus muscles
• These muscles originate outside the tongue and insert into the connective
tissue within the tongue.

• The top and side of the tongue are studded with papillae which is the extension
of lamina propria of mucous which are covered with stratified squamous
epithelium.

Fungiform papillae: - Mushroom shaped covers a large area of tongue. They are
larger towards the rear of tongue and smaller on the tip and sides. It contains taste
buds.

Filiform papillae: - long and thin, consist of touch receptor, most numerous, covers
2/3rd of tongue

Vallate papillae: usually between 8 and 12 altogether are arranged in an inverted V

shape towards the base of the tongue. Largest of the papillae
Lingual glands: are in the lamina propria of the tongues secretes mucu8s and enzyme
lingual lipase
• A fold of mucous membrane on the underside of tongue the lingual frenulum
which attaches the tongue to the floor of mouth
Applied anatomy:
Ankyloglossia Condition in which lingual frenulum is short or malformed

Function of tongue:
• The muscle of the tongue performs some important function in digestion
o Position food for optimal chewing
o Gather food into bolus
o Position food is it can be swallowed.
• The enzyme lingual lipase secreted by lingual gland plays a minor role in
breaking down triglycerides
• The papillae consist of nerve endings of the sense of taste which are called taste
buds

Blood Supply to tongue

Lingual branch of external carotid artery
Venous drainage
Lingual vein which drains into internal jugular vein

Nerve supply
Hypoglossal nerve: - Supply voluntary muscle tissue.
Lingual branch of the mandibular nerves – nerves of somatic sensation

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 Fascial and glossopharyngeal nerve – nerves of the special sensation of taste

SALIVARY GLAND
• Salivary glands are minor exocrine gland which are housed with in the
membranes of mouth and tongue.
• The salivary gland secretes saliva directly into oral cavity or indirectly
through duct
• An average of 1 to 1.5 liters of saliva is secreted each day
• In addition to salivary gland, the buccal gland in cheeks palatal gland in the
palate and lingual glands in the tongue helps supplies with adequate saliva
• The major Salivary gland:
• Outside the oral mucosa are 3 pairs of major salivary gland which secrets
majority of saliva into duct that opens into the mouth

There are three pairs of major salivary glands

1. The submandibular glands: -

2. The sublingual glands:
3. The parotid gland:
Blood Supply:
• arterial supply – from ext. carotid arteries
• venous supply – into the ext. jugular vein.
SALIVA
Composition
• Saliva is secreted by salivary glands consist of 99.5% water and 0.5% solutes.
• The solutes are ions like sodium, potassium, chloride bi carbonate phosphate
some dissolved gases, various organic substances including urea uric acid
mucus, immunoglobulin. A lysozyme (bacteriolytic enzymes) and salivary
amylase, glycoproteins growth factor.

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 • The enzyme salivary amylase breaks down carbohydrate and it continues
acting until it is inactivated by stomach acid
• Bicarbonate and phosphate ions functions as chemical buffers maintaining
saliva at PH 6.54 - 6.85
• Salivary mucus helps to lubricate food, facilitating movement in the mouth,
bolus formation and swallowing.
• Immunoglobulin prevents microbes from penetrating the epithelium and
lysozymes major salivary gland secretes different type of saliva according to
their cellular makeup.
o Parotid gland – watery solution containing salivary amylase
o Submandibular gland – liquid thickened with mucus and contains
salivary amylase
o Sublingual gland – thick mucus with very less salivary amylase.
Applied physiology
Sialorrhea – increased salivation
Hyposalivation – decreased salivation

Function of Saliva:
1. Lubrication: -
Saliva helps in easy swallowing of food as it lubricates food. It keeps the
mucous membrane moist and lubricate the tongue and lips during speech.
2. Appreciation of taste: -
The food that gets dissolve in the saliva can stimulate taste bud.
3. Digestive Function: -
Saliva contains salivary amylase, an enzyme which converts cooked starch into
maltose.
Lingual lipase another enzyme has a weak action on lipid digestion.
4. Defense: -
Saliva contains, lysozyme and immunoglobulin which can attack the
microorganism that enters the oral cavity.
5. Other functions: -
Saliva helps to cool the hot food stuff
Many metals like lead and mercury are excreted through saliva.
TEETH
Location:
• The teeth are accessory digestive organ located in sockets of the alveolar
processes of the mandible and maxillae.
• The alveolar processes are covered by gingival (or gums) which extend into
each socket.
• The sockets are lined by the periodontal ligament or membrane which consist
of dense fibrous tissue. That anchors the teeth to the socket wall.
Structure:

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 • There are 3 major regions of a typical tooth. They are:
o The crown
o Root (1to3 embedded in socket)
o Neck (junction of crown and root)
• Internally, dentin (calcified connective tissue gives the tooth its basic shape
and rigidity
• Dentin of crown is covered by enamel (calcium phosphate + calcium carbonate)
hardest substance in body
• Dentin of the root is covered by cementum which attaches the root to the
periodontal ligament.
• Dentin of a tooth encloses pulp cavity in the crown (filled with pulp, a connective
tissue containing blood vessels nerve and lymphatic vessels) with narrow
extension in the root called root canals, which open at their base by an apical
foreman.

Dentitions:
Human have 2 dentitions or sets of teeth
1. Deciduous
2. Permanent

: Deciduous
• It is also called as primary teeth, milk teeth or baby teeth
• The central and lateral incisors close to the midline are chisel shaped and
adapted for cutting into food
• The canines with a pointed cusp used to tear and shred food
• Incisors and canines have one root a piece
• Posterior to the canine lies the first and second molars which have four cusp, 3
roots in maxillary molars and 2 roots in mandibular molar
• The molar crush and grind the food to prepare it to swallow.

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Permanent Teeth:
•All the deciduous teeth are lost (generally between 6-12 years of age
and replaced by permanent teeth.
• Permanent dentition contains 32 teeth that erupt between 6 & adulthood
• The pattern resembles the deciduous dentition with 1st and 2nd premolar
which replaces deciduous molar
• The [permanent molar erupts posteriorly as the jaw grows to
accommodate them, 1st molar – age 6; 2nd molar – 12 and 3rd molar age
17.
Esophagus or Oesophagus (Anatomy)

• It is a 25cm long collapsible muscular tube with diameter 2 cm

• It lies to the middle of the thorax and posterior to trachea
• Posterior to it lies vertebral column and anterior to it lies trachea and heart.
• It is continuous with pharynx above and below with stomach
• At the level of 10th thoracic vertebrae it passes through diaphragm through an
opening called oesophageal hiatus
• It curves upward before opening into the stomach
• This shape angle prevents regurgitation of gastric content into the
oesophagus
• At the end of the esophagus the muscular layer slightly becomes more
prominent and form 2 sphincters
o Upper oesophageal sphincter (UES)or cricopharyngeal sphincter
between esophagus and pharynx
o Lower oesophageal or cardiac sphincter (LES) between stomach and
oesophagus
• These layers consist of smooth muscles and regulates the entry of food from
esophagus from pharynx and into the stomach
• The superficial layer adventitia attaches oesophagus to surrounding structure
Histology
• The proximal third is lined by stratified squamous epithelium
• The distal third is lined by columnar epithelium
• The middle third is lined by both the above epithelial cell

Blood supply

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Arterial
• The thoracic region: paired esophageal arteries, branches from thoracic aorta
• The abdominal region: Inferior phrenic arteries and left gastric branch of the
coeliac artery.
Venous drainage
• The thoracic region: Azygos an Hemi azygous veins
• Abdominal region: left gastric vein

STOMACH

Location:
The stomach is J shaped dilated portion of the alimentary tract situated in the
epigastric, umbilical, and left hypochondriac region of abdominal cavity.
Organs associated
Anteriorly – left lobe of livers anterior abdominal wall
Posteriorly – abdominal aorta, pancreas, spleen, left kidney, and adrenal gland
Superiorly -= diaphragm, esophagus, and left lobe of liver
Inferiorly – transverse colon and small intestine
To the left – diaphragm and spleen
To the right – liver and duodenum.
Structure of stomach
Sphincters
• The stomach is continuous with the esophagus at the cardiac sphincter

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 • It is continuous with duodenum at pyloric sphincter
• The pyloric sphincter controls the emptying of stomach and it is open when
the stomach is inactive
Parts of stomach
There are four main regions in the stomach
1. cardia
2. fundus
3. Body
4. Pylorus
• Cardia is located inferior to diaphragm
• Above and left of cardia is the dome shaped fundus
• Below fundus is the body the main part of the stomach
• the funnel shaped pylorus connects the stomach with duodenum
• wider end of pylorus is pylorus antrum and narrow end is pylorus canal.
• In the absence of the food the stomach deflates inward and its mucosa and
submucosa fall into a large fold called the rugae.
Curvature of stomach
• The lesser curvature is short lies in the posterior surface of the stomach and
the downward continuation of the posterior wall of the oesophagus
• The anterior region of the stomach angles acutely upwards curves downward
where oesophagus join and it is called great curvature.
Omentum
The stomach was held in the place by
a) Lesser omentum→extends from liver to lesser curvature
b) Greater omentum→runs from greater curvature to posterior abdominal wall
Walls of the stomach or histology of the stomach
The wall of the stomach is made up of four layers
1. Mucosa
2. Submucosa
3. Muscularis
4. Serosa
Mucosa
The mucosa is the three layered
1. Epithelium
2. Lamina propria
3. Muscularis mucosa
Epithelium forms the gastric pit that contains gastric gland.
The gastric glands consist of three types of exocrine gland cells which secretes
about 2000 to 3000ml of gastric juice. They are
a) Mucous neck cell→secretes mucous it is also called as surface mucous cell
b) Parietal cell – produce intrinsic factor (for absorption of B12 and Hcl)
c) Chief Cell – Secretes pepsinogen and gastric lipase

• The gastric gland contains enteroendocrine and cells which secretes

hormones gastrin in blood stream.
Submucosa
It is composed of arrector tissues
Mucusless
• It has 3 layers:

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 o Outer longitudinal
o Middle circular
o Inner oblique layers
Serosa
• It is composed of simple squamous epithelium and areolar connective tissue
the portion of serosa is part of visceral peritoneum
Blood supply
Arterial supply: by left gastric artery, a branch of coeliac artery and right gastric
artery.
Venous drainage: by veins of corresponding artery into portal vein.

Applied aspect or applied anatomy:

1. pylorospasm:
The muscle fibers of the sphincter fail to relax normally so food does not pass from
stomach to intestine which produce vomiting to reduce the pressure in stomach and
it is seen usually in infants.

2. Pyloric stenosis:

It is a narrowing of the pyloric sphincter that must be corrected surgically. Pyloric

stenosis leads to projectile vomiting
3. Gastrectomy:
A medical procedure where all or part of the stomach is surgically removed

There are four types of gastrectomy:

• Total gastrectomy – the whole stomach is removed
• Partial gastrectomy – lower part is removed
• Sleeve gastrectomy – left side of stomach is removed
• Esophagus gastrectomy – the top part and a part of esophagus is removed

Function of stomach:
• It serves as the temporary storage allowing time for the digestive enzymes
and pepsins
• Chemical digestion – pepsin converts proteins to peptides
• Mechanical breakdown – muscle layers of stomach churn, add gastric juice
and the contents are liquified to chyme
• Absorption: -limited absorption of water alcohol and some lipid soluble drug
• Nonspecific defense against microbes – provide by HCl acid in gastric juice
• Absorption of iron is initiated by stomach
Iron are mostly absorbed in ferrous state. But most of the dietary iron is in ferric
form., iron is not absorbed in stomach but the gastric secretion
(HCl) dissolves the iron and permits to form soluble complex with ascorbic acid (Vit-
C) and it is converted to ferrous form
• Production and secretion of intrinsic factor which is needed for absorption of
Vit B12 in terminal ileum.
• Regulation of passage of gastric content into the duodenum
When the chyme is sufficiently acidified and liquefied the pylorus forces small set of
gastric content through pyloric sphincter into the duodenum.
• Secretion of gastrin

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 SMALL INTESTINE (Anatomy)
• The major events of digestion and absorption occur in the small intestine
• It is the longest part of the alimentary canal and continuous with the pyloric
sphincter of stomach and ends in large intestine at ileocecal valve.
• Its length is about 3 meters in a living person and diameter is about 2.5cm

Structure of small intestine

• The coiled tube of small intestine is subdivided into 3 regions from proximal to distal
they are:
o Duodenum
o Jejunum
o Ileum
Duodenum:

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 • The shortest region it is about 25.4 cm long and begins at pyloric sphincter
• After pyloric sphincter it bends posteriorly behind peritoneum becoming
retroperitoneal and then makes a C-shaped curve around the head of pancreas and
ascents to anteriorly again to peritoneal cavity and join jejunum.
• Therefore, it is sub divided into superior descending horizontal and ascending
duodenum
• The hepatopancreatic ampulla (ampulla of Vaster) is located in duodenal wall in
which the bile duct and pancreatic duct enters duodenum

Jejunum:
• Jejunum is about 0.9m long and runs from duodenum to ileum
• Jejunum means empty in Latin

Ileum:
• It is the longest part, measuring about 1.8m in length and thickness, more vascular
and has more mucosal fold than jejunum
• The ileum joins serum of large intestine at ileocecal sphincter
• The ileum and jejunum are tethered (joined) to the posterior abdominal wall by
mesentery.
Histology:
• The wall of small intestine is composed of same four layer of alimentary canal.
• But the features of mucosa and submucosa is different which increase the
absorptive surface area of small intestine which includes
• 1.circular folds
• 2. Villi and micro villi
• These adaptations are most abundant in the proximal 2/3 of small intestine
Circular folds
• It is a deep ridge in mucosa and submucosa, and it is also called plica circular
• It begins near proximal part of duodenum and ends near middle of ileum
• These folds facilitate absorption. It allows the chyme to move spirally which
provides time for absorption of nutrients.
Villi

• It is hair like vascularized projection about 0.5-1 mm long seen within the
circular folds
.

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 Microvilli
• They are cylindrical apical surface extensions of the plasma membrane of
mucosa’s epithelial cells and are supported by micro filaments within those
cells.
• They are about 1um and found in groups and are called brush border
• There are about 200 million microvilli per sq millimeter of small intestine which
increases surface are and helps absorption
Intestinal glands
• The mucosa between the villi is dotted with deep crevices depression that
leads into a tubular intestinal gland (crypts of Lieberkühn)
• These glands have at the base peculiar Argentaffin cells and Paneth cells.

Cells of the small intestinal Mucosa (Histology)

Cell Type Location in Mucosa Function
Absorptive Epithelium / intestinal Digestion and absorption
gland of nutrients in chyme
Goblet Epithelium / intestinal Secretion of mucus
gland
Paneth Intestinal gland Secretion of bactericidal
enzyme
G-cell Intestinal gland of Secretion of hormone
duodenum intestinal gastrin
I-cell Intestinal gland of Secretion of hormone
duodenum cholecystokinin –
stimulate release of bile
and pancreatic juice
k-cell Intestinal gland Secretion of the hormone
Glucose dependent
insulinotropic peptide
M-cell Intestinal gland of Secretion of hormone
duodenum and jejunum motilin – gastric emptying
stimulates intestinal
peristalsis, production of
pepsin
S cell Intestinal gland Secrets secretin

Functions of S.I

Structure Activity Function

A Mucosa /
Submucosa
1 Intestinal Gland Secretes intestinal juices Helps for absorption of
substance from chyme (in
duodenum)
2 Duodenal gland Secretes alkaline juice and Buffers stomach acid and
mucous acts as an lubricant

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 3 Microvilli Secretes brush border
enzymes like
Dextranase converts Dextrin → Glucose
Maltase Converts Maltose → glucose
Sucrase converts Sucrose → Glucose &
Fructose
Lactase converts Lactose – Glucose &
Fructose
Enterokinase converts Trypsin – Trypsinogen
Aminopeptidase converts Amino acids + peptides
4 Villi Finger like projection Increase the site of
secretes mucus absorption
Increase the surface area for
digestion and absorption
5 Circular folds It is the folds of mucous Increase functional area of
and submucous layer absorption and digestion
B Muscularis
1 Segmentation Consist of alternative Mixed chyme with digestive
contraction of smooth juice and brings food into
muscle fibers that produces contact with the mucous for
segmentation and re- absorption
segmentation
2 Migrating motility A type of peristalsis Moves chyme towards
complex consisting of waves of ileocecal sphincter
contraction and relaxation
of circular and longitudinal
smooth muscle fibers
passing the length of small
intestine

Applied Physiology (small intestine)

Lactose intolerance: it occurs when absorptive cell does not produce enzyme
lactose.

LARGE INTESTINE
• It is the terminal part of the alimentary canal.
• The primary function of this organ is to finish absorption of nutrients and
water, synthesize certain vitamins, form feces, and eliminate feces from the
body.

Structure of large intestine:

• The large intestine runs from the appendix to the anus
• The large intestine is about 1.56m long and 6.5cm wide
• It is attached to the posterior abdominal wall by mesocolon, a double layer of
peritoneum

Subdivision
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 • The large intestine is subdivided into four main regions
o The cecum
o The colon
o The rectum
o The anus
• The ileocecal valve located at opening between the ileum and large intestine
control the flow of chyme from small intestine to large intestine
Cecum
• A small pouch of above 6cm long hangs inferior to the ileocecal sphincter
(valve) that guards the opening between the ileum and the large intestine
• Attached to cecum is a twisted wiled tube about 8cm long called the appendix
• Mesoappendix attaches the appendix to the inferior part of the mesentery of
the ileum

Colon:
• Cecum merges with long tube called colon which is divided into
o The ascending colon ascends on the right side of the abdomen
reaches inferior surface of liver and turns abruptly to the lift to form the
right colic flexure
o Transverse colon:
▪ Ascending colon continues across the abdomen to the left to
form transverse colon
▪ It curves below the inferior and of the spleen on the left side as
the left colic flexure (splenic)
o Descending colon:
▪ Transverse colon descends inferiorly to the level of ileac chest
as descending colon

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 o The Sigmoid colon: (S-shaped)
▪ It begins near the left ileac crest projects medially to the midline
and terminates as rectum.
Rectum
• The rectum, the last 20 cm of the GI tract lies anterior to the sacrum and
coccyx
• It is slightly dilated, and it leads from sigmoid colon and terminates in anal
canal

The anal canal:

• The terminal 2-3 cm of rectum is called the anal canal which has longitudinal
folds of mucous membrane called anal columns
• The exterior opening of the anal canal is called anus which is guarded by an
internal anal sphincter of smooth muscle (involuntary) and an external anal
sphincter of skeletal muscle (voluntary)
• Normally these sphincters keep the anus close except during defection

Histology:
The wall of the large intestine consists of typical four layers:
• Mucosa
• Sub Mucosa
• Muscularis mucosa
• serosa

Mucosa:
• It is three layered:
o Simple columnar epithelium
o Lamina propria and muscularis mucosal with long straight tubular
intestinal glands (crypts of Lieberkühn)
o Epithelium contains mainly absorptive cells and goblet cells

Submucosa
• It consists of areolar connective tissue

The muscularis
• It is layered, external of longitudinal smooth muscles internal of circular
smooth muscle
• Portion of longitudinal muscle thicken to form conspicuous longitudinal band
called the taenia coli
• The tonic contractions of the bands gather the colon into series of pouches
called haustra giving it a puckered appearance
• Serosa of the wall is the pact of visceral peritoneum
• Small fat filled pouches are attached to taenia coli called epiploic appendages

Blood supply of large intestine

Arterial supply: Superior and inferior mesenteric arteries
Superior mesenteric artery:

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Caecum, ascending and most of transverse colon
Inferior mesenteric artery supplies the remainder of the colon and the proximal part
of the rectum.
Internal iliac artery: Distal section of the rectum
Venous drainage – superior and inferior mesenteric veins. These veins join the
splenic and gastric vein to form the portal vein.

Functions of large intestine:

• Absorption:
o Contents of ileum which pass through ileocecal valve into caecum fluid
even though a large amount of wale has been absorbed in S.I
o In large intestine abdorpt9ion of water continues until the familiar
semisolid consistency of feces is achieved
o Mineral salts vit and some drugs are also absorbed into the blood
capillaries from large intestine
• Microbial activity
o The large intestine is heavily colonized by certain types of bacteria
which synthesize vit K and folic acid
o They include E-coli, Enterobacter aerogenes, these are normally
harmless in humans. However, they may become pathogenic if
transferred to another part of body.
• Haustral churning
o It moves content from haustrum to haustrum by muscular contraction
o
• Mass peristalsis
o It forces content into sigmoid colon and rectum
• Defecation reflex
o It eliminates feces by contraction in sigmoid colon and rectum

o
PANCREAS

• Pancreas is a pale grey gland weighing about 60gm.

• It is about 12 to 15 cm long and is situated in epigastric and left
hypochondriac region of abdominal cavity.

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 • It consists of abroad head, a body and narrow tail
• The head lies in the curve of the duodenum, the body behind the stomach and
tail lies in front of the right kidney and just reaches spleen
• The abdominal aorta and the inferior vena cava lie behind the gland
• Pancreas is both an exocrine and endocrine gland

Exocrine pancreas (Histology)

• The exocrine part of pancreas arises as little grapes like cell clusters each
called acinus located at the terminal encl of pancreatic ducts.
• These acinar cells secrete enzymes rich pancreatic juice into tiny merging
duct that forms and dominant duct.
• The larger duct fuses with common bile duct carrying bile from the liver and
gall bladder. Just before entering the duodenum through a common opening
the hepatopancreatic ampulla. The smooth muscle sphincter controls the
release of pancreatic juice and bile into small intestine.
• The other duct enters the duodenum directly 1 inch above the
hepatopancreatic ampulla. It is called the duct of Santorini.
• Scattered through the sea of exocrine acini are small island of endocrine cell
the small island of endocrine cells, the islets of Langerhans which produce
hormones pancreatic polypeptide insulin, glucagon, and somatostatin.

Blood supply
The splenic and mesenteric arter4ies supply arterial blood to the pancreas
Venous drainage is by the veins mesenteric and splenic that joins portal vein.

Nerve Supply:
Parasympathetic nerves – increases the secretion
Sympathetic nerves – depress the secretion

Digestive function of the pancreas

The exocrine part of the pancreas consists of ducts and acini which helps to
digestion. The exocrine part secretes pancreatic juice.

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 • The pancreas produces over a liter of pancreatic juice each day
• The pancreatic juice is alkaline in nature about PH 7.1 TO 8.2
• It is clear to composed of water some salts and several digestive enzymes.
Proteolytic enzymes:
o Trypsin
• It is secreted as inactive form trypsinogen. After entering the small intestine, it
is activated to trypsin by the brush border enzyme enteropeptidase:
trypsinogen trypsin
• The active trypsin in turn changes pancreatic enzyme Pro carboxypeptidase
and chymotrypsinogen into their active form carboxypeptidase and
chymotrypsin
Amylolytic Enzyme (α – amylase)

• The starch is split into maltose, maltriose and dextrin.

Lipolytic enzyme
• Pancreatic lipase
• cholesterol ester hydrolase enzyme
• Phospholipase
Nuclease enzyme

• DNA and RNA splits into nucleotides.

Pancreatitis: (inflammation of pancreas).
LIVER
• Liver is the largest gland in the body, weighing about 3 pounds in an adult
• In addition to digestion, it plays major role in digestion and metabolism
• The liver lies inferior to the diaphragm in the right quadrant of abdominal
cavity and receives protection from surrounding ribs.

Location
• It is situated in the upper part of the abdominal cavity occupying the greater
part of the right hypochondriac region, part of the epigastric region and
extending into the left hypochondria region
Organs associated with the liver
• Superiorly and anteriorly – diaphragm and anterior abdominal wall
• Inferiorly – stomach, bile duct, duodenum, hepatic flexure of the colon right
kidney and adrenal gland
• Posteriorly – esophagus, inferior vena cava, aorta, gall bladder, vertebral
column and diaphragm
• Laterally – lower ribs and diaphragm

Structure of liver
• The liver is enclosed in a thin elastic capsule.
• It is incompletely covered by a layer of peritoneum.

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Liver Surfaces
The external surfaces of the liver are described by their location and adjacent
structures. There are two liver surfaces – the diaphragmatic and visceral:
• Diaphragmatic surface – the anterosuperior surface of the liver.
o It is smooth and convex, fitting snugly beneath the curvature of
the diaphragm.
o The posterior aspect of the diaphragmatic surface is not covered by
visceral peritoneum and is in direct contact with the diaphragm itself
(known as the ‘bare area’ of the liver).
• Visceral surface – the posteroinferior surface of the liver.
o With the exception of the fossa of the gallbladder and porta hepatis, it
is covered with peritoneum.
o It is moulded by the shape of the surrounding organs, making it
irregular and flat.
o It lies in contact with the right kidney, right adrenal gland, right colic
flexure, transverse colon, first part of the
duodenum, gallbladder, oesophagus, and the stomach.
Lobes of the liver
• The lobes of the liver are made up of tiny lobules which are hexagonal in
shape
• There are four lobes in liver
• The liver is divided into 2 primary lobes
o A right large lobe
o A much smaller left lobe
• In right lobe again two lobes are seen
o Inferior quadrate lobe
o Posterior caudate lobe

Ligaments of liver
• The liver is connected to the abdominal wall and diaphragm by five peritoneal
folds referred to as ligaments.
o Falciform ligament

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 o Coronary ligament
o Two lateral ligaments
o The ligament teres hepatis
The right and left lobe of liver is separated anteriorly by falciform ligament and the
ligamentum teres hepatis
Histology/ microscopic structure
• The lobes are made up of tiny lobules
• Lobules are composed of cubical shaped cells the hepatocytes
• Kupffer cells is a hepatic macrophage.
Functions of liver
Various functions of liver are carried out by liver cell or hepatocyte.
• Protein synthesis:
o It plays a major role in the synthesis of protein like plasma protein.
Human serum, albumin, osmolyte and carries protein α fet
o o protein the fetal counter part of serum albumin, soluble plasma
fibronectin forming blood clot that stops bleeding
• CHO metabolism
o The liver performs several roles in CHO metabolism:
▪ Gluconeogenesis – synthesis of glucose from certain amino acid
lactate or glycerol
▪ Glycogenesis – formation of glycogen from glucose,
▪ Glycogenolysis – breakdown of glycogen to glucose.
• Lipid metabolism
o Cholesterol synthesis
o Lipogenesis, the production of triglycerides
• Coagulation factor
o The liver produces CF
▪ Fibrinogen
▪ Prothrombin
▪ Labile factor
▪ Stable factor
▪ Christmas factor
▪ Stuart factor
▪ Plasma thromboplastin
o It also produces protein C, protein S and antithrombin
o The liver is a major site of thrombopoietin production thrombopoietin is
a glycoprotein hormone that regulates production of platelets.
• Fetus RBC production
o In the 1st trimester fetus the liver is main site of RBC production later
32nd week of gestation it is carried out by bone marrow.
• Bile (digestive function)
o The liver produces and excretes bile (a yellowish liquid) required for
massifying fats.
• Breakdown
o Breakdown of insulin and other hormones.
o The livery glucuronidases bilirubin, facilitating its excretion into bile
o The liver breaks down modifies substances and most medicinal
products in a process called drug metabolism.

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 o The liver converts ammonia to urea
• Breakdown of erythrocytes and defense against microbes
o This is carried out by phagocytic hepatic macrophages (Kupffer cells)
to the sinusoids (breakdown of RBC also takes place in spleen and
bone marrow
• Production of heat
o The liver uses a considerable amount of energy and has high
metabolic rate and produces a great deal of heat. It is the main heat
producing organ of the body.
• Other functions
o The liver stores in multitude of substances including glucose in the
form of glycogen, Vit a (1-2 years supply) Vit D (1-4 months) Vit B12 (1-
3 years ) iron and cooper.
o The liver is responsible for immunological effect the retile endo thelial
system of the liver contains many immunologically active cell
o The liver synthesizes angiotensinogen a hormone that is responsible
for raising BP when activated by renin an enzyme that is released
when kidney senses low BP

BILE
• Bile is synthesized in the Hepatocytes. Small amount of bile is continuously
transferred to the gall bladder through the cystic duct where it is stored
• Bile has a PH of 8 and between 500 and 1000 ml are secreted daily
Composition of Bile
o Water
o Bile salts
o Mineral Salts
o Mucus
o bile pigment mainly bilirubin
o cholesterol
• in Gall bladder water and mucus and other inorganic constituents are
absorbed therefore organic components become 6 times concentrated
• Bile Salts
o The bile salt is the most important constituent of the bile. They are
sodium and potassium salt of bile acid conjugated to the amino acid

Gall bladder
o Pea shaped sac attached to the posterior surface of the liver by connective
tissue
o It has fundus or expanded end a body or main part and a neck which is
continuous with cystic duct
• Wall
o The wall of gall bladder has some layers of tissues as those described in the
basic structure of alimentary canal with some modification
• Peritoneum

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 o This covers only the inferior surface because the upper surface of gall bladder
is in direct contact with liver and held in place by the visceral peritoneum that
covers the liver.
Structure of Gall bladder:
o There is an additional muscular layer, oblique muscle fibers
o Mucous membrane: This displays small rugae when gall bladder is empty.
That disappears when it is distended with bile.
Blood supply
o The cystic artery a branch of hepatic artery supplies blood to gall bladder
o Blood is drained away by the cystic vein that joins portal venin
Function of Gall bladder
o Reservoir of bile
o It increases the concentration of bile up to 10 to 15-fold by absorption of
water
o Releases stored bile
o When the muscle wall of gall bladder contracts the bile passes through bile
duct to duodenum. This contraction is stimulated by the presence of fat and
acid chyme in the duodenum.
o Relaxation of the hepatopancreatic sphincter is caused by Cholecystokinin
(CCK) and is reflex response to contract of gall bladder.

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